Becker's Spine Review

22 THOUGHT LEADERSHIP we're seeing success across the whole state. Q: ere are well-documented complexities with spine surgery bundled payments. Has EmergeOrtho been able to find success with spine bundles? FA: e limiting factor in participating in commercial bundles is getting the payers to follow. It's a difficult transition for them be- cause they have to change certain things in their infrastructure. We have relationships with at least one commercial payer where we're getting ready to launch spine bundles. It hasn't taken effect yet, but we anticipate it will take off this year. Q: What are some of the challenges you run into as a larger organization that medium- sized orthopedic groups may not run into? FA: ere are definitely challenges in the de- velopmental stage of the practice, particularly when you're bringing in successful groups with their own way of operating and they've been doing things their own way for years. Ev- eryone thinks their way is the best. You have to adapt and look at what the best practices are from each of the regions. Some providers have to philosophically relinquish some of the ways they've been doing things to potentially operate in a better way. at's the first chal- lenge when you're taking on other groups. You also have to gain trust from the provid- ers you're working with, and that can take a couple of years. From there, the challenges from consolida- tion. When everyone's on the same page, you have to then consolidate processes such as back-office functions and eventually get to a point where you develop your C-suite with your statewide CFO and CEO. In the past year, that's what we've done. Now, about 60 percent to 70 percent of the things we do are shared services among all the regions, and the rest of it is still local to certain regions. e challenge now is further consolidation, but we've made huge inroads over the past year. Ultimately, we're trying to further streamline things, im- prove our efficiencies and make EmergeOrtho a leaner organization. Saving money on over- head and doing things the same way can po- tentially lead to better revenue streams. Once you get past the first few years, you get much more buy in. Q: What challenges are you experiencing in your specific geographic region? FA: Because we represent such a broad geo- graphic area, each region serves different patient populations, and each market has dif- ferent competitors. is becomes challeng- ing from a staffing standpoint with regards to employee recruitment and retention. Each re- gion has to adapt to their situation in unique ways to ensure a stable and capable workforce. Every region in EmergeOrtho is on the same page philosophically with the way we practice and how we handle our day-to-day opera- tions, but minor differences exist due to the local landscapes. Q: We're seeing some larger groups, such as Rothman Orthopaedics, expanding into other states. Does there come a point where independent orthopedic groups become too big? FA: I think it's a fine balance between being large enough to effectively serve the geo- graphic area you cover versus being too large that it dilutes your leadership. If you have too many people on your board or leadership council, then it becomes much more difficult to get everybody on the same page to make ef- ficient and effective decisions. I think if you're in one geographic area or state, you can only grow a certain amount. We're at a perfect size now, and how I envision our growth in the fu- ture is through different relationships. I see us collaborating with other groups, not with full-on integration, but through strate- gic relationships, such as clinically integrated networks, to work together on large value- based projects. I also see us growing similar to Rothman, not so much by adding more groups to the "mothership," but by managing smaller groups through management services organizations where they can remain inde- pendent and not have to fully merge with us. We can help them with back-office functions and streamline other processes to keep their practices alive and independent. Q: We've seen a lot of growth in the MSO space this year. How do you envision Emer- geOrtho stepping into the MSO space to help smaller independent practices? FA: You can do that through regional or na- tional MSOs versus doing it independent. We're still in the infancy of discussing how we're going to attack that and develop an MSO, but there are many different ways to ap- proach it. Q: Do you think consolidation will be in- evitable for smaller orthopedic groups chal- lenged with maintaining autonomy? FA: e cost of practicing medicine is astro- nomical, and it's not going down. Especially as we transition to value-based care, the cost is going to increase, because it's a whole new way of practicing. Data collection and data man- agement become so much more important in order to be successful in value-based care, and that's expensive. If the smaller groups want to survive, they have to make a decision to stay independent or fall into a hospital system. If they want to stay independent, they're go- ing to have to look at joining larger groups. It's difficult to survive now, but it's going to be next to impossible to survive as we transi- tion to the next phase of healthcare. Not only value-based care, but as we also transition to direct-to-employer care, you need to be able to provide the full gamut of musculoskeletal services, and it's necessary in a larger group to offer that full spectrum of services. Q: Has EmergeOrtho secured many direct- to-employer partnerships in North Caro- lina? FA: They're only starting to develop now. You don't see it, really, in many parts of the country at this point, but I think a lot of the larger groups are beginning to head in that direction. Q: In the next five years, how do you see EmergeOrtho growing? FA: I don't think we'll add any other large groups because we want to maintain a flex- ible and nimble leadership. If we add too many other groups, you can have too large of a leadership and succumb to paralysis by overanalysis. We want to be able to stay ahead of the curve and be able to make quick deci- sions. I see us potentially adding small groups into the fold without diluting leadership and also managing small groups either alone or in conjunction with other large groups. North Carolina is a certificate of need state, so you can't open ASCs easily. ere have been attempts over the past decade to get rid of CON legislation, so hopefully something will change soon. If that happens, we'll certainly expand into more ASCs. But right now we plan on doing a lot of our expansion through orthopedic urgent care and physical therapy facilities. Q: Personally, what do you hope to achieve over the next five years? FA: I'm in my 23rd year of practice, so I hope to continue to enjoy practicing at a high level. I'm thoroughly enjoying my position as phy- sician president and am putting our organi- zational goals ahead of my personal goals. I want to see us grow and enter the new phases of care and gain a stronghold in value-based care and management. By doing that, we're providing better and more cost-effective care for our patients and can really make a dent in the healthcare expenditure curve. If we do that properly, we can make healthcare better throughout the country, not just EmergeOr- tho, but overall as we transition to a value- based environment. n

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